Ventricular Tumors

2018 ◽  
Author(s):  
Neil Majmundar ◽  
James K. Liu
Keyword(s):  
Tumor Recurrence ◽  
Residual Tumor ◽  
Central Neurocytoma ◽  
Benign Tumors ◽  
Subtotal Resection ◽  
Surgical Removal ◽  
Radiological Findings ◽  
Total Resection ◽  
Conventional Radiotherapy ◽  
Ventricular Tumors

Central neurocytomas are rare benign tumors that are typically located in the lateral ventricles. Because they are typically intraventricular, these tumors tend to present clinically with hydrocephalus. Currently, surgical removal with a gross-total resection is the treatment of choice. Various radiotherapy techniques, including both conventional radiotherapy and stereotactic radiosurgery, have been shown to be useful in cases of residual tumor after subtotal resection and tumor recurrence. This chapter presents a clinical case of central neurocytoma that demonstrates the typical clinical and radiological findings, as well as the diagnostic workup and surgical management of these tumors.

Early results of surgery in patients with nonfunctioning pituitary adenoma and analysis of the risk of tumor recurrence

2008 ◽  
Vol 108 (3) ◽  
pp. 525-532 ◽  
Author(s):  
Marco Losa ◽  
Pietro Mortini ◽  
Raffaella Barzaghi ◽  
Paolo Ribotto ◽  
Maria Rosa Terreni ◽  
...  
Keyword(s):  
Tumor Recurrence ◽  
Postoperative Radiotherapy ◽  
Residual Tumor ◽  
Benign Tumors ◽  
Surgical Removal ◽  
Tumor Diameter ◽  
Tumor Removal ◽  
Early Results ◽  
Results Of Surgery

Object Nonfunctioning pituitary adenomas (NFPAs) are benign tumors of the pituitary gland that typically cause visual and/or hormonal dysfunction. Surgery is the treatment of choice, but patients remain at risk for tumor recurrence for several years afterwards. The authors evaluate the early results of surgery and the long-term risk of tumor recurrence in patients with NFPAs. Methods Between 1990 and 2005, 491 previously untreated patients with NFPA underwent surgery at the Università Vita-Salute. Determinations of recurrence or growth of the residual tumor tissue during the follow-up period were based on neuroradiological criteria. Results Residual tumor after surgery was detected in 173 patients (36.4%). Multivariate analysis showed that invasion of the cavernous sinus, maximum tumor diameter, and absence of tumor apoplexy were associated with an unfavorable surgical outcome. At least 2 sets of follow-up neuroimaging studies were obtained in 436 patients (median follow-up 53 months). Tumors recurred in 83 patients (19.0%). When tumor removal appeared complete, younger age at surgery was associated with a risk of tumor recurrence. In patients with incomplete tumor removal, adjunctive postoperative radiotherapy had a marked protective effect against growth of residual tumor. Conclusions Complete surgical removal of NFPAs can be safely achieved in > 50% of cases. Visual symptoms and, less frequently, pituitary function may improve after surgery. However, tumor can recur in patients after apparently complete surgical removal. In patients with incomplete tumor removal, radiation therapy is the most effective adjuvant therapy for preventing residual tumor growth.

scholarly journals Long-term Follow-up of Pediatric Benign Cerebellar Astrocytomas

Neurosurgery ◽  
2011 ◽  
Vol 70 (1) ◽  
pp. 40-48 ◽  
Author(s):  
Hideki Ogiwara ◽  
Robin M. Bowman ◽  
Tadanori Tomita
Keyword(s):  
Tumor Recurrence ◽  
Spontaneous Regression ◽  
Residual Tumor ◽  
Subtotal Resection ◽  
Total Resection ◽  
Postoperative Imaging ◽  
Group A ◽  
Group B

Abstract BACKGROUND The long-term prognosis of cerebellar astrocytomas needs to be reviewed. OBJECTIVE To elucidate the factors influencing tumor recurrence or progression and to determine how long these patient with cerebellar astrocytomas require surveillance with neuroimaging. METHODS A retrospective review of 101 children surgically treated for a cerebellar astrocytoma and followed up for < 10 years was performed. RESULTS Mean follow-up was 18.4 years. Total resection confirmed by postoperative imaging was performed in 51 patients (50.5%; group A). Twenty-three patients (22.8%) had surgical total resection; however, equivocal residual tumor was found on postoperative imaging (group B). Subtotal resection leaving a portion of brainstem or cerebellar peduncle was performed in 27 patients (26.7; group C). Of these 50 residual tumors, 16 (32%) showed spontaneous regression and 8 (16%) showed arrested growth. Radiographic recurrence or progression was noted in 29 patients (28.7%). Only 3 of 51 patients (5.9%) of group A with total resection had recurrence, whereas 26 of 50 residual tumors (52%; groups B and C) progressed. The only factor affecting recurrence or progression by multivariate analysis was the extent of surgical resection. All tumor recurrence or progression except for 1 (96.6%) occurred within 8 years from the original surgery (range, 2–132 months). CONCLUSIONS Overall prognosis of cerebellar astrocytomas is good; the 10-year survival rate was 100% and recurrence- or progression-free rate was 71.3% in our cohort. Almost half of residual tumors showed spontaneous regression or arrested growth in the long term. Eight to 10 years is considered to be a reasonable follow-up period by neuroimaging.

Stereotactic Radiosurgery for Recurrent Central Neurocytoma: Case Report

Neurosurgery ◽  
2001 ◽  
Vol 48 (2) ◽  
pp. 441-443 ◽  
Author(s):  
Bruce E. Pollock ◽  
Scott L. Stafford
Keyword(s):  
Stereotactic Radiosurgery ◽  
Tumor Recurrence ◽  
Clinical Presentation ◽  
Central Neurocytoma ◽  
Gross Total Resection ◽  
Benign Tumors ◽  
Total Resection ◽  
Aggressive Tumors ◽  
Neurologically Intact ◽  
Viable Treatment

Abstract OBJECTIVE AND IMPORTANCE Neurocytomas are typically benign tumors that have high local control rates after gross total resection. Nevertheless, tumor recurrence is possible, and some patients have aggressive tumors. CLINICAL PRESENTATION A 26-year-old woman had a recurrent, asymptomatic neurocytoma 3 years after gross total resection. INTERVENTION The patient underwent stereotactic radiosurgery for the tumor recurrence. Thirty-four months later, the patient remained neurologically intact, and the tumor had decreased significantly in size. CONCLUSION Radiosurgery may be a viable treatment option for patients with recurrent neurocytomas or for patients whose tumor resections were subtotal.

Patterns of skull base meningioma progression after failed radiosurgery

2007 ◽  
Vol 106 (1) ◽  
pp. 30-35 ◽  
Author(s):  
William T. Couldwell ◽  
Chad D. Cole ◽  
Ossama Al-Mefty
Keyword(s):  
Skull Base ◽  
Stereotactic Radiosurgery ◽  
Growth Patterns ◽  
World Health ◽  
Benign Tumors ◽  
Subtotal Resection ◽  
Surgical Removal ◽  
Skull Base Meningioma ◽  
Number Of Patients ◽  
Health Organization

Object Stereotactic radiosurgery has been reported to be an effective alternative to surgical removal of small to medium benign meningiomas as well as an adjuvant treatment modality to reduce the risk of tumor progression after subtotal resection. Its efficacy has been proved by excellent short-term radiosurgically demonstrated control rates, which have been reported to approach or exceed 90% in many contemporary studies involving the use of either linear accelerator–based systems or the Gamma Knife. Little is known, however, regarding the growth patterns of meningiomas that fail to stabilize after radiosurgery. Methods The authors report 13 cases of benign skull base meningiomas (World Health Organization Grade I) that demonstrated progression after radiosurgical treatment as a primary or an adjuvant therapy. Several tumors demonstrated rapid growth immediately after radiosurgical treatment, whereas other lesions progressed in a very delayed manner in some patients (up to 14 years after treatment). Regardless of the interval after which it occurs, tumor growth can be quite aggressive once it has begun. Conclusions Skull base meningioma growth can be aggressive after failed radiosurgery in some patients, and treatment failure can occur at long intervals following treatment. Special attention must be devoted to such significant occurrences given the increasing number of patients undergoing stereotactic radiosurgery for benign tumors, and careful extended (> 10 years) follow up must be undertaken in all patients after radiosurgery.

scholarly journals STMO-03 ROLE OF INTRAOPERATIVE COMPUTED TOMOGRAPHY IN GLIOBLASTOMA RESECTION GUIDED BY 5-ALA

2019 ◽  
Vol 1 (Supplement_2) ◽  
pp. ii18-ii19
Author(s):  
Takahiro Yamauchi ◽  
Ryuhei Kitai ◽  
Yoshinori Shibaike ◽  
Mizuki Oiwa ◽  
Shintaro Yamada ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Aminolevulinic Acid ◽  
Residual Tumor ◽  
Subtotal Resection ◽  
Resection Rate ◽  
Total Resection ◽  
Intraoperative Computed Tomography ◽  
Postoperative Mri ◽  
The Impact ◽  
Additional Resection

Abstract OBJECTIVE To improve resection rate, multiple operative modalities have been essential for glioblastoma (GBM) surgery. Aim of this study is to clarify the impact of intraoperative computed tomography (i-CT) for GBM surgery with 5-aminolevulinic acid photodynamic diagnosis (5-ALA PDD). METHODS Consecutive 24 patients newly diagnosed GBM were analyzed, retrospectively. To exclude 6 patients decided timing for i-CT based on neural monitoring, 18 patients performed i-CT after total resection of 5-ALA positive lesion were included, finally. RESULTS The median age was 58 years old, and average preoperative tumor volume was 47.78 cm3. Tumor locations were frontal lobe 5 (27%), parietal lobe 3 (17%), temporal lobe 9 (50%), and corpus callosum 1 (6%). Seventeen tumors (78%) harbored in eloquent area. After i-CT performed, 7 (39%) were confirmed residual tumor, and additional resections were needed. Subtotal resection (STR) was 5 and partial resection (PR) was 2 on volumetry in i-CT before additional resection. After additional resection, those cases were judged as 2 gross total resection (GTR), 4 STR and 1 PR in postoperative magnetic resonance imaging (MRI). 11 cases without additional resection were judged as 4 GTR, 3 STR and 4 PR in postoperative MRI. In 18 patients confirmed total resection of 5-ALA positive lesion, i-CT and postoperative MRI revealed 14 (78%) residual tumors. I-CT revealed 7 (50%) in all residual tumor. DISCUSSION Hemorrhage, brain edema, air, invasive lesion, and limitation of resolution of CT might make difficult to detect residual tumor. CONCLUSION I-CT may be useful to detect residual tumor even with 5-ALA and improve resection rate.

scholarly journals Total resection of a giant retroperitoneal and mediastinal ganglioneuroma—case report and systematic review of the literature

2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Patrick Kirchweger ◽  
Helwig Valentin Wundsam ◽  
Ines Fischer ◽  
Christiane Sophie Rösch ◽  
Gernot Böhm ◽  
...  
Keyword(s):  
Case Report ◽  
Abdominal Cavity ◽  
Positive Family History ◽  
Malignant Degeneration ◽  
Benign Tumors ◽  
Surgical Removal ◽  
Histopathological Analysis ◽  
Review Of The Literature ◽  
Total Resection ◽  
Initial Symptoms

Abstract Background Ganglioneuromas (GNs) are extremely rare, slowly growing, benign tumors that can arise from Schwann cells, ganglion cells, and neuronal or fibrous tissues. Due to their origin from the sympathetic neural crest, they show neuroendocrine potential; however, most are reported to be hormonally inactive. Nevertheless, complete surgical removal is recommended for symptom control or for the prevention of potential malignant degeneration. Case Report A 30-year-old female was referred to our oncologic center due to a giant retroperitoneal and mediastinal mass detected in computed tomography (CT) scans. The initial symptoms were transient nausea, diarrhea, and crampy abdominal pain. There was a positive family history including 5 first- and second-degree relatives. Presurgical biopsy revealed a benign ganglioneuroma. Total resection (TR) of a 35 × 25 × 25 cm, 2550-g tumor was obtained successfully via laparotomy combined with thoracotomy and partial incision of the diaphragm. Histopathological analysis confirmed the diagnosis. Surgically challenging aspects were the bilateral tumor invasion from the retroperitoneum into the mediastinum through the aortic hiatus with the need of a bilateral 2-cavity procedure, as well as the tumor-related displacement of the abdominal aorta, the mesenteric vessels, and the inferior vena cava. Due to their anatomic course through the tumor mass, the lumbar aortic vessels needed to be partially resected. Postoperative functioning was excellent without any sign of neurologic deficit. Conclusion Here, we present the largest case of a TR of a GN with retroperitoneal and mediastinal expansion. On review of the literature, this is the largest reported GN resected and was performed safely. Additionally, we present the first systematic literature review for large GN (> 10 cm) as well as for resected tumors growing from the abdominal cavity into the thoracic cavity.

scholarly journals CPA Epidermoid Cyst with Rare Anatomic Variant: Anterior Inferior Cerebellar Artery Embedded in the Subarcuate Fossa: Operative Video and Technical Nuances

2018 ◽  
Vol 80 (S 03) ◽  
pp. S323-S324
Author(s):  
Carlos Candanedo ◽  
Sergey Spektor
Keyword(s):  
Trigeminal Neuralgia ◽  
Epidermoid Cyst ◽  
Abducens Nerve ◽  
Residual Tumor ◽  
Benign Tumors ◽  
Anterior Inferior Cerebellar Artery ◽  
Surgical Removal ◽  
Anatomical Variant ◽  
Cerebellar Artery ◽  
Subarcuate Artery

Intracranial epidermoid cysts are considered benign tumors with a good general prognosis; however, their radical removal, including tumor capsule, is associated with significant morbidity, especially when the capsule is attached to neurovascular structures. We show an operative video describing main steps and surgical nuances in the resection of a large right cerebellopontine angle (CPA) epidermoid cyst in a 42-year-old male patient who presented with intractable trigeminal neuralgia. Craniectomy was performed to exposure the transverse-sigmoid sinus junction. A mold for a polymethylmethacrylate (PMMA) bone flap was built before opening the dura to avoid potentially neurotoxic effects on the cerebellum. The video illustrates the management of the rare anatomical variant of the anterior inferior cerebellar artery (AICA). Its loop was embedded in the dura, covering the subarcuate fossa where it gives off the subarcuate artery. Near total removal of the epidermoid cyst was achieved, leaving only a tiny capsule remnant adhering to the abducens nerve. Postoperatively the patient's trigeminal neuralgia was fully relieved and medications were discontinued. The patient's hearing was preserved per audiometry at the preoperative level (Gardner–Robertson II). Postoperative magnetic resonance imaging (MRI) revealed no signs of residual tumor. In this case, it was not possible to obtain optimal surgical exposure of the CPA without handling a rare anatomical anomaly of the AICA in the dura of the subarcuate fossa, which demanded coagulation and transection of the subarcuate artery and transposition of AICA with the dural cuff. This manipulation enabled optimal surgical removal of the epidermoid and didn't cause any neurological deficit.The link to the video can be found at: https://youtu.be/lLZqBHlu-uA.

Combined Endoscopic and Exoscopic Resection of Intracranial Epidermoid Cysts

2021 ◽  
Author(s):  
Li Chuzhong ◽  
Li Zhenye ◽  
Gui Songbai ◽  
Zhao Peng ◽  
Bai Jiwei ◽  
...  
Keyword(s):  
Residual Tumor ◽  
Subtotal Resection ◽  
Total Resection ◽  
Epidermoid Cysts ◽  
Postoperative Hematoma ◽  
Practical Experiences ◽  
Intracranial Epidermoid ◽  
Further Development ◽  
Panoramic Views

Abstract Objective In the past ten years, a fully endoscopic technique has also been widely used. Exoscope has also been developed for microneurosurgery which offers quality image and convenient manipulation. This article aims at introducing an endoscopic-exoscopic technique for the resection of epidermoid cysts. Methods We retrospectively analyzed the patients with intracranial epidermoid cysts who received whole course combined endoscopic and exoscopic resection between 2017 and 2020 at our institution, to explore the benefit of combined endoscopic and exoscopic resection of intracranial epidermoid cysts and evaluated the clinical utility of endoscopic-exoscopic technique. Results A total of 17 patients were enrolled in the study. Of all patients, 6 patients (6/17, 35.3%) underwent total resection, 10 patients (10/17, 58.8%) underwent subtotal resection (residual capsule and/or) and 1 patients (1/17, 5.9%) underwent partial resection. Postoperative surgical complications were seen in 3 patients (3/17, 17.6%), including intracranial infection in 2 patients (2/17, 11.8%), and a delayed postoperative hematoma observed in the seventh day after operation for 1 patient (1/17, 5.9%), who was treated in a conservative manner and recovered smoothly from the hemorrhage. The median follow-up time was 33.3 months (range 14.5-54.5 months). During the follow-up period, there was no recurrence of the tumors that received total resection. 2 patients developed residual tumor regrowth but did not show any symptom therefore no further surgery was required. Conclusions Endoscopic-exoscopic technique is safe and efficient in the resection of intracranial epidermoid cysts with panoramic views and superior maneuverability. With further development and accumulation of practical experiences, the endoscopic-exoscopic technique can also be applied in the resection of other intracranial tumors.

Treatment-related morbidity and the management of pediatric craniopharyngioma

2012 ◽  
Vol 10 (4) ◽  
pp. 293-301 ◽  
Author(s):  
Aaron J. Clark ◽  
Tene A. Cage ◽  
Derick Aranda ◽  
Andrew T. Parsa ◽  
Kurtis I. Auguste ◽  
...  
Keyword(s):  
Radiation Treatment ◽  
Treatment Strategies ◽  
Extent Of Resection ◽  
Gross Total Resection ◽  
Neurological Deficits ◽  
Benign Tumors ◽  
Subtotal Resection ◽  
Total Resection ◽  
Anatomical Relationship ◽  
Vascular Structures

Object Craniopharyngiomas are benign tumors but their close anatomical relationship with critical neurological, endocrine, and vascular structures makes gross-total resection (GTR) with minimal morbidity difficult to achieve. Currently, there is controversy regarding the extent, timing, and modality of treatment for pediatric craniopharyngioma. Methods The authors performed a systematic review of the published literature on pediatric craniopharyngioma to determine patterns of clinical practice and the reported outcomes of standard treatment strategies. This yielded 109 studies, which contained data describing extent of resection for a total of 531 patients. Differences in outcome were examined based upon extent of resection and choice of radiation treatment. Results Gross-total resection was associated with increased rates of new endocrine dysfunction (OR 5.4, p < 0.001), panhypopituitarism (OR 7.8, p = 0.006), and new neurological deficits (OR 9.9, p = 0.03) compared with biopsy procedures. Subtotal resection (STR) was not associated with an increased rate of new neurological deficits. Gross-total was associated with increased rates of diabetes insipidus (OR 7.7, p = 0.05) compared with the combination of STR and radiotherapy (RT). The addition of RT to STR was associated with increased rates of panhypopituitarism (OR 9.9, p = 0.01) but otherwise similar rates of morbidities. Conclusions Although subject to the limitations of a literature review, this report suggests that GTR is associated with increased rates of endocrinopathies compared with STR + RT, and this should be considered when planning goals of surgery.

scholarly journals Interhemispheric transcallosal approach for resection of intraventricular central neurocytoma

2013 ◽  
Vol 34 (v1supplement) ◽  
pp. 1 ◽  
Author(s):  
James K. Liu
Keyword(s):  
Third Ventricle ◽  
Complete Removal ◽  
Central Neurocytoma ◽  
Benign Tumors ◽  
Surgical Removal ◽  
Tumor Removal ◽  
Transcallosal Approach ◽  
Lateral Ventricles ◽  
Microsurgical Resection ◽  
Intraventricular Tumors

The interhemispheric transcallosal approach is a versatile approach to access intraventricular tumors of the lateral and third ventricles. The advantages of using a transcallosal approach over a classical transcortical approach include a direct midline orientation with symmetrical access to both lateral ventricles and both walls of the third ventricle. In addition, violation of the cerebral cortex and the risk of postoperative seizures can be avoided. Central neurocytomas are rare benign tumors that represent approximately 0.1 to 0.5% of all primary brain tumors. They are typically located in the lateral ventricles and tend to present clinically with hydrocephalus. Currently, surgical removal with a gross-total resection is the treatment of choice. In this operative video manuscript, the author demonstrates an illustrative step-by-step technique for microsurgical resection of a large central neurocytoma involving both lateral ventricles in a patient with hydrocephalus using the interhemispheric transcallosal approach. A complete removal was performed without the need for permanent shunting. The operative technique and surgical nuances, including the surgical approach, intraventricular tumor removal, and closure are illustrated in this video atlas.The video can be found here: http://youtu.be/KzC8QYsTKeg.

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